Prenatal diagnoses of Congenital Anomalies of the Kidney and Urinary Tract (CAKUT) are critical for counseling families about potential postnatal outcomes. While ultrasound (US) remains the gold standard for prenatal diagnosis of CAKUT, fetal magnetic resonance imaging (MRI) has been increasingly used for complex anomalies. However, diagnostic accuracy of fetal MRI for CAKUT remains uncertain. This study aims to compare prenatal US and MRI for the diagnosis of CAKUT. We reviewed charts of gravid mothers with fetuses having suspected CAKUT seen at a tertiary fetal care center between 2012-2020. Data included prenatal US, fetal MRI, prenatal intervention, postnatal US, postnatal MRI, postnatal voiding cystourethrogram, postnatal diagnosis, and postnatal surgical intervention. Prenatal imaging and postnatal diagnoses were categorized into kidney, ureteral, and/or bladder anomalies. Diagnostic accuracy of prenatal imaging for identifying postnatal anomalies was evaluated using sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Anatomic categories were stratified based on concordance between prenatal imaging findings and postnatal diagnosis (concordant, incomplete - imaging that captured accurate details but missed key nuances-, or discordant). Fetal MRI had statistically significant fewer rates of incomplete results compared to US. When anatomic categories were grouped together, fetal MRI had greater sensitivity, PPV, and NPV, and equivalent specificity compared to US. This relationship held true for kidney and ureteral anomalies. In the bladder, MRI and US had equivalent diagnostic accuracy. However, these results of sensitivity, specificity, PPV, and NPV within anatomic categories were not statistically significant. Although fetal MRI showed greater sensitivity, PPV, and NPV for detecting kidney and ureteral anomalies, these differences were not statistically significant. MRI should nonetheless be considered complementary to prenatal US as it may provide more detailed information, particularly for complex congenital kidney and ureteral anomalies. The data demonstrate meaningful clinical differences between US and MRI in diagnosing CAKUT. Further work is needed to validate these findings in a larger cohort.
Stroke remains a rare but life-threatening complication of pregnancy, with significant implications for both maternal and fetal health. Current stroke prevention and treatment guidelines offer limited guidance for managing stroke in pregnant and postpartum patients. Despite advances in obstetric and neurological care, the diagnosis and management of pregnancy-associated stroke continue to be challenged by delayed recognition, a lack of tailored clinical guidelines, and persistent disparities in outcomes. This scientific statement represents a multidisciplinary effort to synthesize current knowledge of the risk factors and diverse causes of stroke in pregnancy and to offer consensus-driven suggestions for prevention, acute management, and postpartum recovery. Nearly half of all US pregnancy-associated stroke hospitalizations occur in the setting of hypertensive disorders. Primary stroke prevention strategies include risk factor modification, aggressive hypertension management and prompt treatment of severe hypertension in pregnancy and postpartum, and antithrombotic therapy in some high-risk groups. Secondary stroke prevention strategies in pregnancy depend on the mechanism of the prior stroke. Pregnancy should not delay evidence-based treatments for acute stroke. The use of telemedicine can facilitate early consultation with a vascular neurologist and a maternal-fetal medicine specialist in cases of acute pregnancy-related stroke, helping to guide initial decision-making. Computed tomography, computed tomography angiography, and magnetic resonance imaging without contrast are all safe neuroimaging modalities for rapid evaluation of pregnant patients with acute stroke symptoms. Acute stroke alone is not an indication for immediate delivery, and stabilization of the mother should come first. Vaginal delivery after stroke is preferred when feasible because it avoids the surgical risks and hemodynamic stress associated with cesarean delivery. Survivors of pregnancy-associated stroke face unique challenges such as caring for an infant and breastfeeding and require support from a multidisciplinary rehabilitation team. Continued research, including inclusive clinical trials, is urgently needed to refine stroke risk assessment, to expand treatment options, and to improve maternal outcomes.
The aim of this study was to assess the longitudinal intrathoracic changes after pleuroamniotic shunting (PAS) in fetuses with massive unilateral or bilateral hydrothorax. The presence of intrafetal fluid effusions and the observed/expected lung-to-head ratio (O/E-LHR) of both lungs were weekly evaluated in a cohort of fetuses with severe hydrothorax treated PAS in a single reference center in Mexico. Severe fetal hydrothorax was diagnosed as an accumulation of fluid within the fetal pleural space accompanied with severe bilateral lung compression, mediastinal shift, polyhydramnios, and/or hydrops. The longitudinal changes in intrafetal fluid effusions, and pulmonary growth were analyzed by survival and multilevel analysis against weeks after fetal intervention. Fifty-six pregnancies with severe fetal hydrothorax were treated with PAS at a median gestational age of 30.1 (range, 20.8-36.1) weeks. After shunting, all cases were longitudinally analyzed and in whom a total of 332 scans were performed (median 6, range 2-16). A complete disappearance of hydrops and hydrothorax was observed at a median interval of 1.6 and 5.9 weeks after PAS, respectively. A progressive increase in lung growth was observed, becoming normal O/E-LHR at on average 7.0 weeks after PAS. Fetal PAS promotes disappearance of all fetal fluid effusions and a normalization of the pulmonary growth after fetal intervention.
This study aimed to compare the effects of insulin pump intensive therapy alone with those of insulin pump intensive therapy combined with metformin or dapagliflozin on the time to achieve glycemic targets, total insulin dose at the end of intensive therapy, and pancreatic function. The study aimed to understand the impact of adding the traditional antidiabetic drug metformin and the novel antidiabetic drug dapagliflozin to routine intensive insulin therapy on treatment outcomes. A total of 110 patients with newly diagnosed T2DM (with glycated hemoglobin >9%, fasting blood glucose >11.1 mmol/L, or obvious symptoms of hyperglycemia) were enrolled in a single-center randomized controlled trial. Patients were randomized into three groups. The final analysis included 81 participants (73.6% of the enrolled) with complete data for the primary outcomes, distributed as follows: Group 1 (insulin only, n = 25), Group 2 (insulin plus dapagliflozin, n = 20), and Group 3 (insulin plus metformin, n = 36). The term "newly diagnosed" was defined as a diagnosis confirmed within 1 year prior to enrollment, in accordance with the Chinese guidelines for the prevention and treatment of T2DM. All patients were either treatment-naïve or had not received any sustained glucose-lowering pharmacotherapy for more than 2 weeks since diagnosis. The primary outcomes were the time to achieve glycemic targets, total insulin dose at the end of intensive therapy, and pancreatic function. The fasting insulin levels in all the treatment groups changed over time, with greater decreases observed in the insulin pump therapy alone group and the insulin pump therapy + dapagliflozin group than in the insulin pump therapy + metformin group. These findings suggest that compared with metformin, dapagliflozin combined with intensive insulin pump therapy holds greater promise for optimizing glycaemic control in patients with T2DM, thus providing a more promising option for clinical practice.
Aim: To study the effect of infertility support education on treatment outcomes in women with unexplained infertility. Materials & methods: This quasi-experimental study with a pretest-posttest comparison group was conducted on women aged 19-45 years who were admitted to EO University Health, Practice and Research Hospital Department of Reproductive Endocrinology and Private D Health Hospital IVF Clinic with the diagnosis of unexplained infertility and decided to undergo in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) and were included in the treatment plan. A study group and a control group were formed by randomization method with at least 25 infertile women for each group. Data were collected using the Introductory questionnaire, Fertility Readiness Scale for women receiving fertility support, Healthy Lifestyle Behaviors Scale II and post-IVF/ICSI success evaluation form. The pretest scales were administered to the education and control groups at the first interview. Infertility support training was given to the education group in three sessions at 15-day intervals. Post-test data were obtained at the interview on the day of ovum pickup. Embryo transfer was performed in 25 infertile women in both groups, and human chorionic gonadotropic hormone evaluation was performed on day 12. Approximately 4 weeks later the presence of a fetal heartbeat was analyzed by reviewing the medical records, and the post-IVF/ICSI success evaluation form was completed. Results: Fetal heartbeat was detected in 15 women in the training group and only in 10 women in the control group, although the pregnancy rate increased after training and this difference was not statistically significant. Conclusion: Infertility support education has been found to have positive effects on fertility as well as general health. What is this article about? This study explored whether ‘infertility support education’ can help women with unexplained infertility during their tube-baby (IVF) treatment. The education program aimed to increase women’s emotional readiness, support their healthy lifestyle habits and possibly improve early pregnancy results. What did the researchers do? Women with unexplained infertility were randomly placed into two groups. Education group: received three sessions of infertility support education over 45 days; control group: continued routine care. Before and after the program, both groups completed questionnaires about fertility readiness and healthy lifestyle behaviors. After the tube-baby treatment, pregnancy outcomes (fetal heartbeat) were checked. What were the results? Women who received the education showed increase in fertility readiness and healthy lifestyle scores. A fetal heartbeat was found in 15 women in the education group and 10 women in the control group. Although the education group had a higher pregnancy rate, the difference was not statistically significant. What do the results mean and why is this important? The supportive education helped women feel more prepared for treatment and adopt healthier lifestyle habits – two important factors in coping with the emotional and physical challenges of infertility. Although pregnancy results did not differ significantly, the program may still provide meaningful psychological and behavioral benefits for women undergoing tube-baby (IVF) treatment. Further research with larger groups is needed to determine its full impact on pregnancy outcomes.
Genetic counseling has become a cornerstone of care in inherited endocrine and metabolic disorders, complementing clinical evaluation with molecular diagnosis and personalized risk assessment. In endocrinology, although many conditions are initially suspected based on clinical and biochemical findings, genetic testing refines diagnosis, clarifies prognosis, and guides long-term management including genetic counselling. Identification of pathogenic variants in genes such as MEN1, NR5A1, GNAS, PHEX, or CYP21A2 enables tailored surveillance, early detection of complications, and cascade screening of at-risk relatives. Beyond individual patient care, genetic counseling plays a pivotal role in reproductive medicine. By explaining inheritance patterns, including autosomal dominant, autosomal recessive, X-linked transmission, and imprinting mechanisms, it allows accurate estimation of recurrence risks and informed reproductive decision-making. Carrier detection, partner screening, prenatal diagnosis, and preimplantation genetic testing are integral components of this approach, particularly in disorders with significant morbidity or variable expressivity. Genetic consultation is also essential in the management of fetal anomalies detected on ultrasound. It supports diagnostic clarification, proposes appropriate molecular investigations, refines prognostic assessment, and addresses recurrence risk in future pregnancies. Importantly, counseling provides psychosocial support, helping families navigate uncertainty and complex medical decisions. Overall, integrating genetic counseling into endocrine practice promotes prevention, optimizes follow-up, enhances reproductive care, and fosters a proactive, family-centered model of management in hereditary endocrine diseases.
Trauma and childbirth-related posttraumatic stress disorder (c-PTSD) are underrecognized possible consequences of birth and obstetric care that may affect maternal well-being, parent-infant bonding, and future reproductive decisions. Despite a growing body of research, gaps remain in the implementation of robust screening, timely diagnosis, and trauma-informed practices to prevent and address c-PTSD. Review our current understanding of psychological birth trauma and c-PTSD, emphasizing provider roles in prevention, identification, and management. PubMed and Google Scholar literature search from 2000 to 2024. Birth trauma is a subjective experience, often driven by factors such as poor communication, lack of informed consent, and perceived loss of control. Only a subset of individuals with traumatic births develops c-PTSD. Prior trauma, mental health conditions, obstetric complications, and inadequate support exacerbate risk. c-PTSD affects approximately 3% to 6% of low-risk, postpartum individuals and up to 18% of postpartum individuals in high-risk populations. Diagnosis requires assessment of associated symptoms with validated tools. Interventions range from psychosocial support, medications, and trauma-focused therapies. Preventive strategies include maternal mental health collaborative models and trauma-informed care that emphasizes respectful communication, autonomy, and continuity of care. Obstetric providers are key actors in shaping a positive childbirth experience through respectful communication and shared decision-making. Early follow-up, mental health screening, and collaborative, trauma-informed care may help mitigate long-term psychological sequelae of birth trauma and c-PTSD to improve outcomes for birthing individuals and families.
Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is a major cause of severe thrombocytopenia, intracranial hemorrhage, and long-term neurological impairment in otherwise healthy neonates. Current management strategies are largely reactive, relying on maternal intravenous immunoglobulin (IVIG), intrauterine platelet transfusions, and postnatal supportive care. Although these interventions can be lifesaving, they are associated with considerable risks, inconsistent efficacy, and significant maternal and healthcare burdens, underscoring the need for a paradigm shift toward prevention. Recent advances in screening, including human platelet antigen genotyping, maternal antibody testing, and the development of non-invasive prenatal testing (NIPT), offer promising opportunities for earlier and safer identification of at-risk pregnancies. At the same time, therapeutic innovation is reshaping the field: monoclonal antibodies targeting Fcγ receptors or FcRn-mediated pathways, strategies to optimize IVIG dosing through pharmacokinetic refinement and biomarker guidance, and experimental tolerogenic approaches collectively illustrate the transition from reactive to proactive care. Looking ahead, the integration of point-of-care diagnostics, artificial intelligence-driven risk prediction, and randomized trials of monoclonal antibody-based prophylaxis may enable population-wide prevention and improve maternal-neonatal outcomes. Together, these developments signal a fundamental transformation in the management of FNAIT, from responding to clinical crises after fetal injury has occurred to preventing disease before it manifests.
Split cord malformation (SCM) is an uncommon congenital anomaly in which the spinal cord is longitudinally divided into two hemicords separated by a fibrous, cartilaginous, or osseous septum. Historically described as diastematomyelia or diplomyelia, the unified classification proposed by Pang et al. [Neurosurgery. 1992;31(3):451-80] distinguishes two main subtypes: type I, characterized by two hemicords within separate dural sacs divided by a rigid spur, and type II, in which hemicords share a single dural sac separated by a fibrous band. Composite SCM, involving multiple noncontiguous lesions, is exceedingly rare. Although SCM is most often recognized in childhood following neurological symptoms or cutaneous stigmata, advances in fetal ultrasonography and MRI now permit prenatal diagnosis. This shift carries significant implications for obstetric counseling, delivery planning, and multidisciplinary perinatal care. While surgical correction in infancy remains the mainstay of treatment, the growing ability to detect SCM in utero has prompted discussion of fetal therapy. Unlike open spina bifida, SCM is primarily a tethering disorder rather than a neural tube closure defect, and no evidence currently supports fetal intervention. This review covers the embryology, classification, epidemiology, clinical features, diagnostics, and management of SCM, with emphasis on prenatal imaging, obstetric considerations, and future prospects for fetal therapy. SCM encompasses distinct subtypes defined by dural anatomy and septum composition. Prenatal imaging has transformed antenatal detection, reshaping obstetric and multidisciplinary planning. As a tethering disorder rather than a neural tube defect, SCM does not currently warrant fetal intervention, and postnatal surgical untethering remains the standard of care.
To assess the postnatal cerebrospinal fluid diversion (CSFD) rates and associated prenatal risk factors (RF) in patients with open fetal spina bifida (fSB) repair over a 4-year follow-up. In 185 patients, CSFD rate was determined at one year, and incremental risk (IR) for CSFD at 2 and 4 years. Characteristics of children without CSFD were compared to those with CSFD, and multiple regression analysis evaluated RF. Sixty-four children (35%) needed CSFD within the first year. These children had larger head circumference (HC) at screening (p=0.001) and before delivery (p<0.001), and larger ventricles at screening (Vp-screening), and before delivery (Vp-delivery) (each p<0.001). Multiple regression identified only Vp-screening, Vp-delivery and their delta as independent RF for CSFD. Vp values were higher in children needing CSFD within the first year compared with years 2-4 (p<0.001 and p=0.01), and larger Vp was associated with earlier CSFD in the first year (p = 0.02). IR for CSFD declined over follow-up. The 1-year CSFD rate after open fSB repair was 35%, with decreasing IR through year four. Larger Vp at screening and before delivery, and their delta, were independent RF for CSFD, while HC was not.
Hemoglobin Bart's hydrops fetalis syndrome (BHFS) is the most severe form of α-thalassemia, typically caused by homozygous deletion of α-globin genes. However, rare non-deletional variants, such as Hemoglobin (Hb) Agrinio, can also produce a lethal phenotype. We report a case of homozygous Hb Agrinio (HBA2:c.89T>C, p.Leu30Pro) diagnosed prenatally in a fetus of Bulgarian origin presenting with hydrops and severe anemia at 23 weeks of gestation. Following diagnosis, the pregnancy was managed with five intrauterine transfusions, resulting in resolution of hydrops and prolongation of pregnancy to term. The neonate was delivered at 37+3 weeks, required transient respiratory and cardiovascular support, and remains clinically stable at 3 months of age under regular transfusion therapy. To our knowledge, this is only the second reported case of BHFS resulting from homozygous Hb Agrinio successfully managed with intrauterine transfusions, and uniquely, the first to achieve term delivery. This case highlights the importance of considering unstable α-globin variants in the differential diagnosis of unexplained fetal hydrops in an at-risk population. Early diagnosis and timely intrauterine transfusions can significantly improve the perinatal outcomes in these cases.
To evaluate the effect of aspirin on gestational age at delivery due to preterm pre-eclampsia (PE) in women with chronic hypertension (CH), to assess the predictive performance of the Fetal Medicine Foundation (FMF) first-trimester competing-risks model for preterm PE in this high-risk group and to evaluate how parity, previous PE and biomarker values influence individualized risk estimates. We analyzed data from two multicenter first-trimester PE screening studies: the Combined Multimarker Screening and Randomized Patient Treatment with Aspirin for Evidence-based Preeclampsia Prevention trial and the Screening Program for Preeclampsia trial. The effect of aspirin on gestational age at delivery due to PE was assessed using Bayesian inference. The screening performance of the FMF model was evaluated by discrimination, calibration and decision-curve analysis. The influence of parity, previous PE and biomarkers (mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI) and placental growth factor (PlGF)) on risk classification was explored using empirical data and Monte Carlo simulations with generalized additive models. The combined dataset included 51 024 women with a singleton pregnancy, of whom 556 (1.1%) had CH. Among the women with CH, 58 (10.4%) developed preterm PE. Bayesian analysis indicated that aspirin delayed delivery due to PE by a mean of 3.6 (95% credible interval, 0.2-6.6) weeks, with a 98% posterior probability of benefit. The FMF model demonstrated good discrimination (area under the receiver-operating-characteristics curve, 0.819 (95% CI, 0.763-0.874)), adequate calibration and higher net benefit compared with a treat-all approach. Overall, 21.8% of women with CH were classified as low risk (< 1 in 100) for preterm PE, consisting mostly of nulliparous women and parous women without previous PE. Predicted risks for preterm PE were strongly influenced by MAP and PlGF, with UtA-PI contributing to a lesser extent. In women with CH, aspirin can delay delivery due to preterm PE, and first-trimester risk assessment using the FMF competing-risks model reliably identifies low- and high-risk individuals. The predicted risk is driven primarily by MAP and PlGF, supporting risk stratification and individualized management in early pregnancy. © 2026 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
To explore preliminary associations between antenatal sonographic parameters and early childhood neurodevelopmental outcomes in fetuses with fetal growth restriction (FGR) or small for gestational age (SGA). FGR was defined as estimated fetal weight (EFW) < 3rd percentile or abnormal Doppler. SGA was defined as EFW 3rd -10th percentile with normal Doppler. This pilot exploratory study (n=32; 28 FGR, 4 SGA) included infants with available Bayley-III Scales of Infant Development (BSID) scores from a larger prospective cohort of 90 FGR/SGA pregnancies. Sonographic parameters from the final pre-delivery ultrasound included abdominal circumference (AC), umbilical vein flow (UVF), corpus callosum length (CCL), cerebellar vermian height (CVH), transverse cerebellar diameter (TCD), and insular circumference to head circumference ratio (IC/HC). Associations between sonographic parameters and BSID neurodevelopmental outcomes were assessed. Multivariate linear regression model were constructed for each BSID scale using significant predictors. In this subset, AC (r = 0.516, p = 0.003) and EFW (r = 0.462, p = 0.008) were associated with motor scores; UVF was associated with language (r = 0.545, p = 0.001) and total scores (r = 0.440, p = 0.012); and IC/HC was associated with adaptive behavior (r = -0.478, p = 0.006). In multivariable models, AC remained associated with motor outcomes (β = 0.369, 95% CI 0.04 - 1.08), UVF with language outcomes (β = 0.408, 95% CI 0.07-0.67), and IC/HC with adaptive behavior (β = -0.474, 95% CI -826.04 - -170.78). After adjusting for gestational age at delivery, UVF and IC/HC associations remained significant. Findings should be interpreted cautiously, given the small sample size. AC, UVF, and IC/HC may have preliminary associations with early neurodevelopmental outcomes. These findings are hypothesis-generating and warrant validation in larger cohorts before clinical application.
Pregnancy-associated venous thromboembolism (pVTE) is a notable cause of maternal morbidity and mortality. Yet, robust comparisons across studies are hampered by inconsistencies in outcome reporting. This study determined the state of outcome reporting in studies addressing prevention and management of pVTE. In this scoping review, we searched 7 databases including Medline, Embase, the Cochrane databases and 3 international trial registries. Clinical trials, registrations, and observational studies (prospective and retrospective) focusing on prevention or management of pVTE, published in English between 1998 and November 2018, were included. We recorded study characteristics, reported outcomes and their definitions, and categorized outcomes in accordance with a published taxonomy for outcomes in medical research. We conducted descriptive analysis to demonstrate variation in reporting and definition of outcomes and the representation of outcomes by categories in the taxonomy. Of 7541 results, 70 studies were included. We extracted 387 outcomes and consolidated these to a final list of 35 outcomes. All studies reported clinical/physiological maternal outcomes, while fewer reported on maternal mortality (10/70), life impact/functioning (8/70), adverse events (27/70), and resource use (6/70). Fetal outcomes were reported in 32 of 70 studies. There was little consistency in outcome definition. Considerable variation exists in the reporting and definition of outcomes in studies addressing pVTE, with lack of representation from core areas other than clinical/physiological outcomes. Further work to standardize outcome reporting, and incorporation of patient-important outcomes in future research will be indispensable to advance evidence-informed and patient-centered care for this population.
Toxoplasmosis is a widespread protozoan infection that exhibits increased pathogenicity in its congenital form. The diagnosis and management of this condition require high accuracy and rapid intervention throughout the maternal-fetal and neonatal periods. The aim of this review is to provide an updated overview of screening and diagnostic confirmation strategies for congenital toxoplasmosis, covering prenatal screening, neonatal assessment and long-term follow-up. It also examines therapeutic options for prenatal treatment based on gestational age. Diagnostic strategies for congenital toxoplasmosis remain highly heterogeneous worldwide, ranging from intensive prenatal screening to a complete absence of systematic testing. When implemented, screening programs promote early diagnosis and treatment, with a positive impact on transmission and disease severity. The recent withdrawal of various key serological tests has forced laboratories to adopt and validate alternative diagnostic algorithms in complex situations. Pyrimethamine-sulfonamide is the cornerstone of treatment, but its toxicity profile remains a major limitation of current management. Cotrimoxazole appears to be a better-tolerated alternative that warrants consideration, although studies are still scarce.
Pulmonary embolism (PE) is a leading cause of death in pregnant and postpartum women. To evaluate the clinical presentation, management and outcomes of pregnancy-related PE managed by a multidisciplinary team. A retrospective review was conducted of pregnant and postpartum women diagnosed with PE between 2018 and 2024 at a tertiary hospital in Johannesburg, South Africa. Pretest probability scores (pregnancy-adapted YEARS and Geneva) were applied in a subgroup with D-dimers available. Seventy-seven women were included: 33 with antepartum and 44 with postpartum PE. The median (interquartile range) age was 29 (9) years, and most were of black African ethnicity. PE risk factors were present in 85% of antepartum and 96% of postpartum cases. Women with antepartum PE more frequently presented with chest pain, shortness of breath and palpitations (p<0.05). Pretest probability scores were assessed in a subgroup with D-dimers available. Based on the pregnancy-adapted YEARS and Geneva scores, imaging would have been required to rule out PE in 87.8% and 73.5% of cases, respectively. Computed tomography pulmonary angiography was the preferred diagnostic modality in 74.0%. Most women (97.4%) were treated as inpatients, and 57% required management in the intensive care and/or high care units. The median length of hospital stay was 14 (8) days. Low-molecular-weight heparin was the most frequently prescribed anticoagulant, with a median treatment duration of 3 (1) months. The live birth rate was 84.4%. One maternal death occurred due to sepsis, unrelated to venous thromboembolism. Antepartum/secondary postpartum major bleeding and primary postpartum major bleeding occurred in 6.5% and 3.9%, respectively. Pregnancy-associated PE managed by a multidisciplinary team was associated with favourable maternal and fetal outcomes.
To evaluate the clinical and economic impact of universal screening for cytomegalovirus (CMV) in pregnant women in Italy, with valacyclovir (VCV) therapy in the case of maternal primary CMV infection, compared with no screening. We developed a decision-analytic model using a deterministic decision tree and compared the no-screening strategy (Scenario 1) with universal screening until 13 + 6 weeks' gestation (Scenario 2), and universal screening until 23 + 6 weeks' gestation (Scenario 3) as recommended by the Italian National Health Service. The model was applied in a hypothetical population of 400 000 pregnant women, representative of the annual number of women giving birth in Italy. Only women susceptible to primary CMV infection were considered, in whom CMV screening by serological testing (IgG/IgM testing ± IgG avidity), followed by VCV treatment (8 g/day) in the case of primary CMV infection, is recommended. Outcomes included the numbers of primary maternal CMV infections diagnosed, fetal congenital CMV (cCMV) infections, terminations of pregnancy (TOPs) and symptomatic and asymptomatic neonatal cCMV infections, and the cost per symptomatic cCMV case avoided (in Euros (€)) from the perspective of the Italian National Health Service. Universal screening until 13 + 6 weeks' gestation would identify 910 maternal primary CMV infections. Compared with no screening, it would prevent 92% of symptomatic cCMV infections (183 vs 15 cases) and prevent 70% of TOPs (33 vs 10 cases). Extending the universal screening period to 23 + 6 weeks' gestation would result in 280 additional diagnoses of maternal primary CMV infection and a further 2% and 9% reduction in symptomatic cCMV infections and TOPs, respectively. Both screening strategies would increase costs by approximately €7 million compared with Scenario 1, with a cost per symptomatic cCMV case avoided of ~ €45 500 for Scenario 2 and ~ €44 400 for Scenario 3. Universal serological CMV screening in pregnancy until 24 weeks' gestation, with VCV treatment in the case of maternal primary infection, substantially reduces the burden of cCMV-related disabilities and appears economically justifiable in the Italian healthcare context. These findings may inform policy decisions in countries with a similar CMV seroprevalence and National Health Service. © 2026 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
To assess fetal sylvian fissure (SF) development via MRI to early detect cortical abnormalities by quantifying the morphological characteristics. This study retrospectively evaluated the prenatal MRI of 324 normal singleton pregnancies at 22-38+6 weeks of gestation (GA). Biparietal diameter (BPD), insula depth (ID), sylvian fissure width (SFW), uncovered insula length (UIL), uncovered insula rate (UIR), sylvian fissure depth (SFD), sylvian fissure anterior depth (SFAD), sylvian fissure posterior depth (SFPD), sylvian fissure superior depth (SFSD) and sylvian fissure inferior depth (SFID) were obtained in the axial and coronal positions. Reproducibility was assessed using 40 cases and verified using the intraclass correlation coefficient (ICC). Correlations with GA were analyzed, and growth charts were drawn using optimal curve fitting. A paired-sample t-test was used to compare the left-right disparities, and an independent-sample t-test was used to compare the differences between SFAD and SFPD, and between SFID and SFSD. To evaluate clinical utility, we applied the normative charts to two fetuses with genetically confirmed cerebral cortical malformations. Interobserver agreements were reproducible (ICC: 0.870-0.988). Reference ranges for sylvian fissure parameters were established. All SF parameters showed a significant correlation with GA (|r| = 0.386 - 0.965, p < 0.05). Axial measurements showed left-right differences in SFW and UIR. SFPD was longer than SFAD bilaterally (p < 0.05). In comparison, SFID was significantly longer than SFSD only on the left side (p < 0.05). The model detected two genetically confirmed cases of polymicrogyria at 26+6 and 30 weeks of gestation and identified subtle focal structural abnormalities undetectable by routine imaging, revealing widespread asymmetrical sylvian fissure defects. The development of the sylvian fissure is dynamic throughout gestation and is a reliable feature of fetal cortex gyration. We provide certain reference standards of prenatal MRI to assist in diagnosing abnormal fetal cerebral cortex development.
To estimate the residual risk of maternal-fetal transmission after primary cytomegalovirus (CMV) infection in the periconceptional period or the first trimester in women treated with valacyclovir, and to assess whether the presence of glycoprotein B2 (gB2)-specific immunoglobulin (Ig)-G antibodies on immunoblot analysis refines fetal risk prediction. This was a retrospective single-center study conducted at University Hospital Tübingen, Tübingen, Germany, between October 2023 and June 2025. Pregnant women with a primary CMV infection diagnosed < 14 weeks' gestation who received valacyclovir (8 g/day) were included in the study. The diagnosis of a recent primary CMV infection was based on maternal serology results, specifically positive anti-CMV-immunoglobulin (Ig)-G and -IgM levels, and low or intermediate IgG avidity. Additionally, prior to initiation of valacyclovir treatment, the presence or absence of glycoprotein B (gB)2-specific IgG antibodies was determined using a commercial line immunoblot. The primary outcome was maternal-fetal transmission of CMV detected at the time of second-trimester amniocentesis. Eighty-five women met the inclusion criteria, including 47 with periconceptional and 38 with first-trimester maternal CMV infection. Median maternal and gestational age at the time of diagnosis of primary maternal CMV infection were 33.1 (interquartile range (IQR), 29.9-34.9) years and 7.4 (IQR, 6.4-8.9) weeks, respectively. Amniocentesis was performed at a median gestational age of 20.6 (IQR, 20.1-21.0) weeks. Overall, maternal-fetal transmission was detected in 7/85 (8.2%) cases at the time of amniocentesis. All CMV transmissions occurred in women without gB2-specific IgG antibodies (7/55 (12.7%)), while no transmissions occurred in those with gB2-specific IgG antibodies (0/30 (0%)) (P = 0.048). In women with a primary CMV infection treated with valacyclovir, the presence of gB2-specific IgG antibodies on immunoblot analysis identifies a subgroup with a low residual risk of maternal-fetal transmission. Incorporating gB2-specific IgG antibodies status into risk stratification may improve patient counseling and clinical decision-making. © 2026 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Objective To evaluate the association between fetal right pulmonary artery (RPA) parameters and postnatal ductus arteriosus velocity-time integral (DA VTI) ratios in neonates with mild or moderate left-sided congenital diaphragmatic hernia (L-CDH), and their predictive value for clinical outcomes. Methods In this prospective cohort study, 49 fetuses with mild or moderate L-CDH were evaluated between 2012-2018. RPA diameter and pulsatility index (PI) were measured at 19-24, 25-29, and 30-32 weeks gestational age (GA). Postnatal DA VTI ratios were assessed at initial echocardiography after birth. An abnormal DA VTI ratio (<1.0) served as the primary outcome. Associations between prenatal RPA parameters, postnatal DA VTI ratios, and neonatal outcomes were analyzed. Results A smaller RPA diameter at 30-32 weeks GA was associated with an abnormal DA VTI ratio (p=0.015). An RPA diameter cutoff of 2.71 mm yielded 60% sensitivity and 84% specificity (AUC=0.74, p=0.005). Neonates with abnormal DA VTI ratios had higher rates of pulmonary hypertension treatment, need for extracorporeal membrane oxygenation, and lower survival. No associations were found between prenatal RPA PI and DA VTI ratios. Conclusion In mild and moderate L-CDH, smaller RPA diameters in third-trimester associate with abnormal DA VTI ratio on initial echocardiography after birth.